| NPI | 1619547387 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAVEN A FISHER Owner 779-296-2838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| 261QM0801X | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2021-06-25 |
| Last Update Date | 2024-02-05 |